Toddcast - S05 E01 - Steve

Toddcast - Season 5, Episode 1

“Steve”

This episode of Toddcast is not sponsored. For information on supporting the
podcast or sponsoring an episode, you can email todd@toddlyons.ca

(SOUNDS: city streets, people, traffic)

TODD: There's a crisis building in our country, and it's closer than we think.

(alternating news soundbites)

Ontario's capital city is staring down a deadly spike in opioid use and
overdose.

It's easy to imagine that it only affects, the poor, the homeless, the people outside of our
circle.

People around here are used to milligrams. These drugs are lethal in
micro-grams.

But with every day that passes, it spreads... into the suburbs and rural communities.

This is devastating news from Abbotsford and we have been seeing four people
a day dying in British Columbia, on average.

But we don't talk about it. We try not to think about it. And in doing so, we encourage
secrecy. We create the environment that deters people from seeking intervention.

If people were prescribed the medication they needed or were given the proper
services, maybe they wouldn't be here in the first place.

We create a terrible choice for people in crisis. Save your life, at the cost of your dignity.

Fentanvl-related fatalities in Ontario have spiked.

Because who would ever look at them the same way again? Who would ever trust them
to the same degree again?

Canada has surpassed the US to become the highest opioid-consuming
country per capita in the world.

The answer must be... you.

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I know someone who struggled for years, in plain sight.

I'm proud to call him my friend.

STEVE: Hi, I'm Steve. I'm currently 56 years old, former public servant. I was a project
lead for accessibility in the Government of Canada, 35 year career, retired. I don't look to
the future right now. I know there is one. I'm working on present. How did we get here?
Yeah. How did we get here?

TODD: Steve lives 8 minutes away from me. When he left the public service we began
having coffee regularly and started a transition from being virtual colleagues to live
friends. At first, we talked about all the usual things—work, family—and then he
dropped this:

STEVE: I have been opioid—can I say free? I don't think I'm free yet. I'm not
currently using opioid pain medications. Twenty-ten was when I started heavy duty
pain meds.

TODD: This is not the person I thought I knew, and I might never have known had Steve
not chosen to share it with me, or, if the unthinkable might have happened to him.

That's why the crisis we're facing now in this country is so perilous. We don't see it right
in front of us. We don't see it.

(news soundbites)

He ’.v in his mid-thirties, lives in the St. John’s area, is well educated and up
until recently had a high-paying job in his field.

Seniors have the highest rates of hospitalization from opiods.

The Canadian Institute for Health Information identified 1,846
hospitalizations for babies born dependant on opioids.

To stave off the growing crisis requires that we acknowledge the unthinkable. That we
confront what we'd rather not. Opiods are an epidemic that transcends socioeconomic
status, and the ones most at risk are the ones you would least expect.

They are the people you know, trying to hold on. Degreed professionals, probably
married with children, with no prior history of problematic substance use disorder, but
faced with a mental or physical illness that threatens to crumble who and what they are
from within. They are fighting on the inside to hold onto what they used to take for
granted—having enough strength to complete that project, make that deadline, get
through one more day, keep putting one foot in front of the other. Working and living
through pain. Sometimes pretending through shame.

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And the transition into problem use isn't something clearly foreseeable.

It can start with the correct course of action: a trip to the doctor.

STEVE: I was originally diagnosed with degenerative disc disorder in September of
2001.1 mean, I was, I was at the point where I couldn't, I couldn't take 20 steps without
having to sit down because of pain, I mean, stairs were my nemesis. After multiple
attempts to control pain through NSAIDs—non-steroidal anti-inflammatories—some of
them very strong which had its own complete set of side effects, including constant
nausea that, that stretch was about six, seven years.

We were experimenting with medications and um, therapies, uh, pain management
clinics, the whole gamut. In 2009,1 was advised I should retire. I chose to keep
working and my doctor decided we would do everything that we could to keep me
employed or keep me working as long as possible and that was the beginning of
stronger pain medications. We started with Oxy and I couldn't handle it. I couldn't
take that. I lasted about a week, it would be five pills out of a prescription for 100.

Then I sent them back to the pharmacy. It made my skin crawl. I was laid out on the
couch, couldn't even move my eyes without nausea and we're talking violently ill. I
decided we wouldn't do that anymore. My doctor was right there, fully supported it.

We tried another medication called Butrans administered via a patch and that was
fantastic. Didn't get high, took the pain away, and I developed a skin
reaction—contact reaction—to the medication.

Most people will have a reaction to the adhesive for the patch. I had a reaction to
the contacts for the medication part. You leave the patch on a week, then you
change it. You have to find a new spot. What happened with me is that the first
patch, by the end of the first week, I was itchy like crazy. I took the patch off and I
had a square that was like a burn and a couple of days later it turns brown. It's
crusty. It got down to the point where the reaction would kick in the day after, so I
could tell my body was building up a dislike for this. Then we switched to
fentanyl—clear patch, big mistake. Don't put a medication like that in a clear patch
because people will forget that they have one on and as the medication, as you get
used to it, you'll build up a resistance—a tolerance—and you might put another one
on by mistake. Like Oxy, I took a reaction to that. Again, wanting to crawl out of
my own skin. Heart racing. Pupils dilated like crazy, extremely alert, which is not
on the, um, the list of potential side effects. Usually it's drowsiness, shallow
breathing, et cetera, et cetera. Almost like an amphetamine, very interesting feeling
at 4:00 in the morning.

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TODD: Steve was doing everything right but there's no magic bullet for pain
management. He's tried more treatments than he can remember. After we spoke, he
contacted me to say that he'd also been on Pregabalin for a time, but it had caused
bruising. But that's medicine. Effects and side effects. Finding the right treatment is best
guess. Trial and error. Cycling through the latest drugs and the old standbys.
Substitutions and combinations.

STEVE: Morphine was very under-powered, very overrated. I might as well have
been taking children's aspirin for that, for all the relief it provided. What we did
ultimately stumble upon was Tramadol, post-surgery medication. It took the edge
off. See, I've never been looking to be pain-free. I was looking to be pain-tolerant.

There's a big difference there. What can I manage? What can I function on? All of
the documentation that came with it said, you know, may cause drowsiness. Again,
shallow breathing, don't take it if you have COPD, which my doctor decided that
the benefit was... outweighed the risk. We also decided on using Zytram as well
along with the Tramadol and it's a long acting one, so you have one for
maintenance, one for breakthrough pain, and also an antidepressant was prescribed
at the same time, so I got a prescription for all three at the same time.

The antidepressant was not for depression. It was an additional pain relief. I'm not
really sure of the mechanics of how that worked. It was an ancillary effect of that. It
had pain management benefits, so getting used to that one was interesting. It really
levelled out my mood. I had no high, I had no low, I was just floating and that lasted
for several months. Drove my wife mad. Uh, I didn't care. It didn't, it didn't bother
me a bit, you know, I was just immune to all external stimuli. Fortunately that
passed, but the medications did level everything out over the years and I was using
that right up through a number of events that happened after.

TODD: Steve's worries about health weren't confined to just his own. His wife was
suffering with rheumatoid arthritis. For years he had held the role of concurrent
caregiver—keeping himself functioning in the workplace while trying to care for his ailing
wife at home.

A typical day would involve getting ready for work, making sure something was
prepared in case she felt she could eat in the morning, then arriving at work for 6:00 am.
He'd check in throughout the morning to see how she was feeling then leave work by
two or two thirty to be home as early as possible.

Some days he would arrive home to a silent house, and fear the worst. Walking slowly
to the bedroom door he would wait motionless, silently, listening for the sound of her
breathing. And then, when he heard it, he could breathe again. But it took its toll.

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STEVE: To be perfectly honest, at the same time, I'm not going to say I was
abusing alcohol. I had an affinity for it. It was a take it or leave it, but I would rather
take it.

Uh, when I left it, I left with for weeks. When I took it, I took it daily, but it was
also for management, I guess you would call it, and everything turns into a habit
now and then. Or, eventually.

TODD: As his wife's disease grew increasingly debilitating, the emotional torment
compounded his physical suffering. He began following his prescription to the letter.

STEVE: I would take the Zytram, which was the baseline pain management and I
would take the breakthrough medication as needed, which was its intent. After
awhile, “as needed” became more frequent. If I missed or didn't take it at a
semi-regular schedule, I would wind up with a considerable amount of discomfort
and then I would take it, wait a couple hours for it to kick in and I decided let's go
for avoidance and I turned it into a regimen. So when it was like every four hours as
required well it was required every four hours. So I was about six a day of those.

Plus the Zytram, plus the antidepressant and the alcohol. And I was doing fine.

I was working, just finished the standard on web accessibility for the Government
of Canada as coauthor. I did a stint at, finished my stint at Treasury Board the year
after we put out the standard. Then I was at the Canada School of the Public Service
working on the training curriculum for the standard and this was in the middle of
Tramadol. Antidepressant. Alcohol. Going to work 6:00 in the morning, leaving at
2:30, three in the afternoon, fully functional— I think—and no one's told me any
different. Everybody seemed to um not want to see me go, but a few incidents
happened between, um, between then and my retirement.

TODD: Steve refers to this part of his life as sleepwalking. By all appearances he was
awake and engaged, but in actuality not in direct contact with the people in his life. The
meds and the alcohol were a buffer not merely from the physical and emotional pain,
but from most feelings. He was numb.

As her condition worsened, his wife increasing refused to see her doctor. While she
never tired of life with him, she was tired of being sick.

It was on October 17th, her 52nd birthday, that he finally convinced her that she could
refuse him no more.

He drove her to the hospital emergency room, brought her in with a wheelchair, and left
to park his car. By the time he returned they'd already taken her away.

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For four days he continued to shuttle between work and the hospital because she
refused to keep him from his job. Then, on the fifth day, finally some news. A phone call
that woke up from his sleep. “You'd better come... now.”

He did. And for the two years that followed it's hard to remember what happened.

STEVE: I sleptwalked through my retirement. I sleptwalked through the... through
the loss of my wife. I'm not sure, sometimes I think being medicated through that
wasn't the worst thing that could have happened at the time, but I didn't need the
guilt that came when I realized that I was absent for a great part of our relationship.

But she'd be much happier with me now. I'm much happier with me now.

The journey back started, I'm going to have to say September of last year. It was
extremely agitated, frustrated, isolated, medicated—very, very angry at myself and
the world just happened to get a bit of that thrown in, too. And I quit alcohol. About
a month after that, after introspection—a lot of introspection—I decided to stop
taking pain medication as well. The absence of alcohol cleared my head a little bit
to the point that I thought I've missed a lot of stuff over the last number of years,
being there but not really present because of the medications. There is also a side
benefit to that. I'll circle around in my own way, but again, on November 16th, I
decided to stop taking pain medication in the manner that I had been, you know, I
was going to severely reduce it. I figured I would keep the baseline one and try to
do without the breakthrough medication.

That worked pretty good for a few days and I stopped doing the baseline medication
and the day following that was actually really, really great. I woke, I was alert, I
was clearheaded. It was 5:00 in the morning. I couldn't wait to get going. I went out.

I had a bunch of stuff on my list I had to do. I went to seven places in three hours.
Normally that list would take me all week to get through. The most useful thing I
started doing at that moment was keeping notes to myself on my phone. I started a
daily diary and I kept that up for several months and it made me focus on how I felt
because as I alluded to, I didn't feel a lot for a number of years and in that state I
could see what I had done wrong.

No, I'm not going to blame anybody—what could've been done better and what I
could do in the future. I stopped that journal right around the time the withdrawal
started easing off because I knew I was in for it. I knew that first couple of days of
mania would pass and that there'd be a price to pay and that price is really, really
high. That's an emotional blender. Picture every emotion you've ever had all at
once—all at once—laughing hysterically, bawling like a baby. The only one that is
really distinct is rage, because rage takes all your attention and that one's scary. I've

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never thrown anything in anger in my life until early December and then everything
was, everything was a potential projectile. In the middle of my wall, in my living
room, there's a spot. That spot is residue from a cheap mini keyboard remote for an
Android TV box. We didn't agree one day and that spot on my wall was where the
remote left its mark.

So about that time I got in touch with my doctor again and told him what I was
doing. Another brilliant move, stopping opioid medications without medical advice
or assistance. All they said was, “Good on ya”. And they, they figured I was doing
pretty good and probably only had another month left until the withdrawal started
easing off. And it was about that time that my doctor, my family doctor retired and I
was introduced to his, um, his replacement. Nice young guy. He didn't care for the
idea of substituting opioids with medical marijuana or whatever to ease the
withdrawal symptoms. And I figured I'd go along with that. I did for awhile and
again, the withdrawal was unpleasant but not completely unmanageable. In
retrospect, it was worse in my mind the anticipation of what could happen to what,
what it physically felt like. It's amazing how your emotions can override your
physical or amplify a physical condition.

So one day I called my doctor's office and I said, this withdrawal is getting too
intense, you know, want to crawl out of my skin. I'm angry, I'm nauseous all the
time. My clothes weren't fitting because I was not losing weight, but just losing
dimensions because my new exercise routine was a 30 minute retch. Uh, so I called
the doctor and I said to his nurse, I said, look, this can happen three ways. One, I
can get a referral to a medical marijuana specialist and the doctor can be in the loop.
Two, I can go and they'll see me without a referral, but the doctor won't be in the
loop or I can go to the street and do it on my own. And then nobody's in the loop.
They call back a couple hours later, I have a referral and I'm still of two minds with
that.

It seemed to ease the withdrawal. It did nothing for the pain. Absolutely nothing.
And as a matter of fact, no, I've pretty much given up on the medical marijuana part
of it. It's just another expense that I don't need. The one real benefit of the medical
marijuana, I lost all interest in alcohol, completely lost all interest in it. Even with
stopping the medical marijuana, that interest hasn't come back in. Somehow that
that circuit got interrupted. Now, if I could only find the pain circuit.

That pretty much brings me to today and today is a lot better. The pain is still there.
It always will be, near as I know. My experience hasn't been typical of what I've

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read, what I've seen when I watched television. Another thing that I've quit to ease
my mood, um, my, my anger and my rage was fed by media, be it social, be it
broadcast.

I didn't like much at the point I quit. I didn't like myself much at the point I quit and
when I say I quit, it was my decision, but that's not the way it happens for most
people. I have some discipline, mental discipline. I had been dealing with Tinnitus
for 25 years. When that first developed and I got accustomed to dealing with it and
became unmedicated again because I was taking antidepressants. So I have a bit of a
history here. I've done this before. I kind of have an idea what to expect and yes, I
was drinking at that time too. The Tinnitus was really what spurred my alcohol as
medicine. Yeah. So we had a long history. Anyway, to get back to it, my experience
isn't typical. I realize that we are in the midst of an epidemic and yes, I will call it an
epidemic.

It is spreading. As a society, we have to rethink how we treat or how we look at
addiction. It's not a personal failing. It's a health problem. There has to be another
way to to deal with all this then we're dealing with it now. Is it a... is there a better
way? Probably. We haven't tried them all yet, so I don't know which one's going to
be the best way. I, I just believe that all evidence shows that the way we're dealing
with it now is wrong. We don't know the story behind the statistics and the statistics
are changing. It's not just marginalized people. With current drugs, if you broke a
leg or if you strained your back and you started Oxy for a month, normal, you
know, regime takes a little while, a couple of weeks, a month, um, you know it's
supposed to be used for as short as possible a time.

You could take anyone, put them in a damaged situation: broken legs, strained back,
slipped disc, whatever. A month later you have someone addicted to narcotics, to
opioids. You suddenly cut them off of that after maintaining it for let's say six
months without substitution, without help, without serious counselling. You've just
made a drug addict and if they can't get it through their doctor, they're going to get it
somewhere. And right now we don't know what is on the street.

Fentanyl, carfentanil, they're synthetic opioids, you know it's not like heroin or
something that was derived from a plant. We're talking stuff that you can cook with
a handful of chemicals that individually are legal and combine them at such an
inexpensive rate and you'll have the market flooded, which is what's happened and
we're never going to stem that supply. What we have to look at is curbing the
demand and whether it be through treatment programs where drugs are provided at

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a known quality, quantity, frequency, maintenance to keep people off the street, to
keep them from dying and alleyways to keep them functioning in the workforce, in
the federal public service, because if you don't think they're there now, oh,
someone's fooling themselves because they could be your colleague.

They could be the guy sitting on the other side of the cubicle. I was doing it for a
number of years in government. As I said I was functioning and I know there's
others out there and they are currently employed. They're probably barely hanging
on emotionally or they're numb as all get out because that's always an option.

I recently heard of a program for chronic alcoholics where people who are addicted
who can't quit on their own, are actually given a dose of wine at particular times
throughout the day and it takes them from a precarious state on the street to a
functional state where they can, if they choose, be a contributor to society, but more
importantly in their own eyes, no longer a drain on society and the risk and the cost
is minimal compared to abandoning them.

Should we do that with narcotics? Opiates? Sure. Why not? Fighting it is not
helping and the only way to not lose is stop fighting it. If we put half the resources
into helping people that we put into incarcerating them or picking them up off the
street when the worst happens, we'll be far better ahead as a society. Am I saying
fully legalizing all drugs? No. I think decriminalizing and taking the money we put
into prosecution and put it into treatment, whether it be treatment with the long-term
goal of abstinence or maintenance, it doesn't matter. We'll still win.

TODD: You've been listening to Toddcast.

All opinions expressed on Toddcast are strictly those of the individual and are not
necessarily those of their employer. Special thanks to our patrons: Steve Buell,
Elizabeth Ellis, Steph and Aaron Percival, M.F. Burford, George Wenzel, Rod
Gallant and Pamela James.

Thanks also to Health Canada for information, advice and support.

However you found us, please help us bring meaningful content to the public
service. Become a subscriber, share the episodes, rate our content, and write, and
let us know what's on your mind. You can reach me at todd@toddlyons.ca.

This episode's music was by Chris Zabriskie.

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Audio clips in this production are used under the fair dealing provisions in
Canadian Copyright Law for education, research and review. I wish to
acknowledge and thank the Canadian Intellectual Property Office for general
advice, and TV Ontario, Global TV, CTV Television, and the Canadian
Broadcasting Corporation for soundbites while noting that this production is not
associated with or endorsed by the aforementioned organizations.

Toddcast is produced using open source software and is free to use and share
under the Creative Commons Attribution Share-Alike license because, like open
source, open content and open licensing makes the world a better place.

I'm Todd Lyons. I'll see you online.

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